Provider Demographics
NPI:1023862893
Name:SPARKS, CARTER
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:
Last Name:SPARKS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SKYLINE DR APT 45
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-4622
Mailing Address - Country:US
Mailing Address - Phone:706-346-9768
Mailing Address - Fax:
Practice Address - Street 1:1600 CORNELL ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-4613
Practice Address - Country:US
Practice Address - Phone:706-346-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician